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NPI Code Detail

MEDICARE: THOMAS J CARLSEN MD

MEDICARE:   THOMAS J CARLSEN  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) PhysicianMD12666OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MD12666OTHEROROBME
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962407585
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS J CARLSEN MD
Provider Business Mailing Address
First Line : 2200 NE NEFF RD
Second Line : STE 200
City : BEND
State : OR
Zip : 97701-4281
Country : US
Telephone Number : 541-382-3344
Fax Number : 541-382-1681
Provider Business Practice Location Address
First Line : 2200 NE NEFF RD
Second Line : STE 200
City : BEND
State : OR
Zip : 97701-4281
Country : US
Telephone Number : 541-382-3344
Fax Number : 541-382-1681
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 07/08/2007

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Directions to “ THOMAS J CARLSEN MD” Practice Location

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